We report the case of a 40-year-old man, transferred from another hospital to our ICU because of acute coronary syndrome. Coronarography did not show coronary stenosis. Twenty-four hours monitoring EKG allowed diagnosis of Prinzmetal angina and appropriate therapy was administered. Six months after discharge due recurrence of symptoms, ranolazine was added to therapy. https://www.selleckchem.com/products/gs-441524.html After one year the patient is symptoms free.Left-ventricular non-compaction (LVNC) is a rare form of cardiomyopathy. Its clinical presentation is highly variable and during pregnancy is frequently associated with heart failure, embolic events, and arrhythmias. Herein we report a case of a woman with left ventricular non-compaction who had an automated defibrillator implantation for recurrent ventricular arrhythmias during pregnancy. During pregnancy and at long-term follow-up no interventions of the device were documented. In conclusion, the management of malignant arrhythmias during pregnancy is one of the concerns for patients with LVNC and requires a careful approach in third-level centers.Dear Editor, A 17-year-old boy, diagnosed with Systemic Lupus Erythematosus (SLE), presented to ophthalmology department with gradual painless diminution of vision in both eyes (right more than left). He had already received 6 pulses of cyclophosphamide and steroids at monthly intervals one year back for diffuse alveolar hemorrhage (DAH) and was on maintenance oral 40 mg prednisolone and 3 grams mycophenolate mofetil (MMF). There was no history of oliguria, skin rash, joint pain, oral ulcers, photosensitivity or any neurological deficit in this presentation. There was no proteinuria, hematuria or worsening of renal function.In the last decades, the main evolution in the field of vascular surgery was correlated to the development and introduction of vascular substitutes. Currently, two types of synthetic vascular substitutes have been widely adopted polyethylene terephthalate and expanded polytetrafluoroethylene. Ideally, they should demonstrate a behavior as close as possible as that of human arteries in terms of mechanical and biological properties. However, no vascular substitute has been found to compare with the patency rates of gold-standard autologous conduits, and major drawbacks of current vascular substitutes remain both thrombogenicity and infectability.Septal myectomy during open aortic valve replacement (AVR) is an effective surgical treatment for asymmetric secondary basal septal hypertrophy. Concerns regarding higher rates of complications associated with this procedure-such as permanent pacemaker implantation-have been raised. The aim of this study is to compare outcomes and complications of patients with and without concomitant septal myectomy using propensity score matching applied to a large, consecutive single center cohort.
A total of 2199 consecutive patients undergoing either AVR with concomitant myectomy (AVR-M, N=212) or AVR alone (N=1987) were analyzed (2009-2015). Patients with previous cardiac or emergency surgery, concomitant cardiac procedures and endocarditis were excluded. As reference to previously published data, patient characteristics and outcomes of the overall cohort were examined and for comparison between groups propensity score matching utilized.
In the unmatched cohort, AVR-M patients were older (71.2±8 vs 67.6±10 years, my seems not to be associated with an increased pacemaker implantation rate.Aim of this study is to identify clinical, electrocardiographic (ECG) and procedural predictors for permanent pacemaker (PPM) requirement after transaortic valve implantation (TAVI).
All consecutive patients with severe symptomatic aortic stenosis (SSAS) undergoing TAVI at our single centre were included in the study and prospectively followed. All patients had standard 12-leads ECGs recordings before and after TAVI and continuous ECG monitoring during hospital stay. Primary endpoint was to identify electrocardiographic predictors of PPM implantation after TAVI; secondary endpoint was to ascertain other clinical or procedure-related predictive factors of PPM need. PPM implantation was further arbitrarily divided into early and late one (beyond the 3rd day).
Among the 431 patients undergoing TAVI between 2008 and 2018, 77 (18%) needed PPM implantation; 47 (11%) had an early procedure, and 30 (7%) a late implant. Pre-operative RBBB implies more than five-fold increase of the risk of PPM implantation (OR 5.19, CI 1.99 - 13.56, P=0.001), whereas the use of a selfexpandable prosthesis is associated with an almost three-fold increase of the risk (OR 2.60, CI 1.28 - 5.28, P=0.008). In the late PPM implantation subgroup, only the history of syncope retains a significant association with such an increased risk (OR 2.71, CI 1.09 - 6.75, P=0.032).
The need of a PPM in the individual TAVI patient is hardly predictable. However, the finding of pre-existing RBBB, the use of self-expandable prosthesis and history of syncope can individuate patients at increased risk.
The need of a PPM in the individual TAVI patient is hardly predictable. However, the finding of pre-existing RBBB, the use of self-expandable prosthesis and history of syncope can individuate patients at increased risk.Acute aortic occlusion (AAO) represents potentially fatal acute vascular emergency that requires prompt diagnosis and intervention. Clinical condition of patients with AAO is frequently severely devastated when surgical intervention is questionable. Our objective was to retrospectively review our institutional experience with AAO and assess predictors of intrahospital mortality and morbidity.
This is retrospective single-center cohort study with prospectively collected data between January 1st 2005 and January 1st 2018. The total number of 28 consecutive patients with AAO were included in our analysis. Patients with acute aortic thrombosis manifested by bilateral acute limb ischemia were divided in two groups based on potential caues of AAO (embolism or in situ thrombosis) differentiated according to condition of aortoilical segment.
We identified 28 patients with AAO. All of them underwent , either aortobifemoral bypass (n20, 71.%) or bilateral trans-femoral thrombectomy (n8, 29%). The overall in-hospital mortality was 36%.